Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
George Washington University Biostatistics Center, Washington, District of Columbia.
Am J Perinatol. 2023 Apr;40(6):589-597. doi: 10.1055/a-1970-7892. Epub 2022 Nov 2.
The aim of this study was to evaluate the association of mild gestational diabetes mellitus (GDM) and obesity with metabolic and cardiovascular markers 5 to 10 years after pregnancy.
This was a secondary analysis of 5- to 10-year follow-up study of a mild GDM treatment trial and concurrent observational cohort of participants ineligible for the trial with abnormal 1-hour glucose challenge test only. Participants with 2-hour glucose tolerance test at follow-up were included. The primary exposures were mild GDM and obesity. The outcomes were insulinogenic index (IGI), 1/homeostatic model assessment of insulin resistance (HOMA-IR), and cardiovascular markers vascular endothelial growth factor, (VEGF), vascular cell adhesion molecule 1 (VCAM-1), cluster of differentiation 40 ligand (CD40L), growth differentiation factor 15 (GDF-15), and suppression of tumorgenesis 2 (ST-2). Multivariable linear regression estimated the association of GDM and obesity with biomarkers.
Of 951 participants in the parent study, 642 (68%) were included. Lower 1/HOMA-IR were observed in treated and untreated GDM groups, compared with non-GDM (mean differences, -0.24 and -0.15; 95% confidence intervals [CIs], -0.36 to -0.12 and -0.28 to -0.03, respectively). Lower VCAM-1 (angiogenesis) was observed in treated GDM group (mean difference, -0.11; 95% CI, -0.19 to -0.03). GDM was not associated with IGI or other biomarkers. Obesity was associated with lower 1/HOMA-IR (mean difference, -0.42; 95% CI, -0.52 to -0.32), but not other biomarkers.
Prior GDM and obesity are associated with more insulin resistance but not insulin secretion or consistent cardiovascular dysfunction 5 to 10 years after delivery.
· Mild GDM increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Obesity increases the risk of insulin resistance 5 to 10 years postpartum but not pancreatic dysfunction.. · Neither mild GDM nor obesity increased the risk of cardiovascular dysfunction 5 to 10 years postpartum..
本研究旨在评估妊娠 5 至 10 年后轻度妊娠期糖尿病（GDM）和肥胖与代谢和心血管标志物之间的关联。
这是对轻度 GDM 治疗试验的 5 至 10 年随访研究和仅进行异常 1 小时葡萄糖挑战试验而不符合试验条件的参与者的同期观察队列的二次分析。包括在随访时进行 2 小时葡萄糖耐量试验的参与者。主要暴露因素为轻度 GDM 和肥胖。结局为胰岛素生成指数（IGI）、1/稳态模型评估的胰岛素抵抗（HOMA-IR）和心血管标志物血管内皮生长因子（VEGF）、血管细胞黏附分子 1（VCAM-1）、分化群 40 配体（CD40L）、生长分化因子 15（GDF-15）和抑瘤素 2（ST-2）。多变量线性回归估计了 GDM 和肥胖与生物标志物的关联。
在母研究的 951 名参与者中，有 642 名（68%）被纳入。与非 GDM 相比，治疗和未治疗的 GDM 组的 1/HOMA-IR 较低（平均差异分别为-0.24 和-0.15；95%置信区间[CI]分别为-0.36 至-0.12 和-0.28 至-0.03）。治疗性 GDM 组的 VCAM-1（血管生成）较低（平均差异为-0.11；95%CI 为-0.19 至-0.03）。GDM 与 IGI 或其他生物标志物无关。肥胖与较低的 1/HOMA-IR 相关（平均差异为-0.42；95%CI 为-0.52 至-0.32），但与其他生物标志物无关。
先前的 GDM 和肥胖与分娩后 5 至 10 年内更高的胰岛素抵抗相关，但与胰岛素分泌或一致的心血管功能障碍无关。
·轻度 GDM 会增加产后 5 至 10 年胰岛素抵抗的风险，但不会增加胰腺功能障碍的风险。·肥胖会增加产后 5 至 10 年胰岛素抵抗的风险，但不会增加胰腺功能障碍的风险。·轻度 GDM 或肥胖均不会增加产后 5 至 10 年心血管功能障碍的风险。
